The health boom from economic bust

MEDICAL MATTERS:Recession can be good for your health, writes
MUIRIS HOUSTON

THAT BEING out of work is bad for your health seems pretty self-evident. Indeed, many studies on the impact of temporary unemployment have shown that, at an individual level, this is indeed the case. But there is also solid evidence that death rates in developed countries drop during recessions and increase during boom times.

In terms of business cycles, mortality is procyclical, meaning it goes up with economic expansions and down with contractions, and not countercyclical, as you might expect. So while most countries enjoyed sustained declines in mortality during the last century, the pace of the decline has been slower during economic booms and greater during so-called busts.

One US study found that a 1 per cent rise in a state’s unemployment rate, relative to its historical average, was associated with a 0.5 per cent decrease in total mortality. The effect was particularly strong for young adults in relation to preventable causes of death, including motor vehicle crashes, cardiovascular and liver disease, and influenza and pneumonia. But suicide has been found to be cyclical, meaning that rates go up during economic downturns.

According to Dr Stephen Bezruchka of the School of Public Health at the University of Washington, Seattle, there are myriad mechanisms through which health can improve during economic downturns. Having friends is known to be good for health. Increased leisure time can be used for friendships, exercise and enjoyable physical activity.

“Some studies have suggested that adverse health behaviours such as smoking and excessive alcohol use decline during recessions. Overeating also declines. Conversely, when employment is associated with stress in the workplace and low control on the job, the worker’s health is likely to suffer,” he says.

Writing in the Canadian Medical Association Journal, Bezruchka notes that the effects of stress have also been observed for babies in utero and therefore affect a woman’s offspring.

People drive less often and the number of road accidents declines during a recession, leading to lower mortality from car crashes – one of the main causes of death in young people.

Visits to doctors and other healthcare professionals decline as incomes tighten and, rather than resulting in poorer health outcomes in the short term, it seems this decline leads to a drop in the number of hospital tests being carried out, especially among people who do not have serious health problems. However, a prolonged period of not screening for disease probably stores up problems for the future.

To understand how recessions paradoxically improve the health of populations, we need to look more closely at the determinants of health and, in particular, how societies share resources among their members. An OECD study looked at how total mortality and causes of death varied with national unemployment rates in the 23 member nations from 1960 to 1997.

The authors found that mortality increased during the economic booms, while death rates fell during downturns. Significantly, these effects were more modest in countries with strong labour protection and high levels of spending on social insurance and more pronounced in countries without such safety nets.

A group made up of Germany, the Netherlands, Austria, Norway, France, Finland, Denmark and Sweden, which devoted an average of 28.7 per cent of GDP to social programmes, saw the least impact of recession on health.

But the greatest drop in death rates during recession were observed in a group that included Ireland as well as Japan, the United States, Portugal, Australia and Canada, which spent an average 19 per cent of GDP on social welfare. In other words, a more egalitarian income distribution led to more consistent health outcomes.

Minister for Social Protection Joan Burton says the austerity programme agreed with the Troika necessitates significant cuts in the social welfare budget. Her choice is to increase PRSI rates, reduce benefits or introduce statutory sick pay. For the overall health of the nation, the evidence suggests she needs to avoid any significant reduction in social welfare benefits.